Acceptance and commitment therapy in the treatment of chronic pain

JoAnne Dahl and Tobias Lundgren discuss the use of ACT for the treatment of chronic pain.

They start off with a fascinating observation:

A radical and provocative conclusion drawn by the authors of a Swedish government evaluation (van Tulder, et al., 2000) of all established medical treatments offered today was that the best treatment a primary care physician could give a patient with chronic pain was nothing. Providing no treatment at all had far better results than any of the medical solutions offered today for chronic pain. Most of the pain treatments are designed for and useful for acute pain but used in the long run may create more problems such as substance abuse and avoidance of important activities. Pain, in itself, is an inevitable part of living. Without it we could not survive. The common element in most of the pain treatments developed in western cultures over the past 50 years is that they emphasize avoiding pain or fighting to reduce pain. When pain was unavoidable, we tolerated it. When pain became avoidable, it became intolerable. What we have created, with all of our painkillers and pain management strategies, is an intolerance and increased sensitivity to pain.

And they continue:

Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is an acceptance and mindfulness based approach that can be applied to many problems and disorders, including chronic pain. It appears to be a powerful therapeutic tool that can reduce suffering both for the client and the treating professional. ACT emphasizes observing thoughts and feelings as they are, without trying to change them, and behaving in ways consistent with valued goals and life directions. ACT has shown promising results in several recent studies (Bach & Hayes, 2000; Bond & Bunce, 2000; Dahl, Wilson & Nilsson, in press; McCracken, Vowles & Eccleston, 2004; Zettle, 2003).

The basic premise of ACT as applied to chronic pain is that while pain hurts, it is the struggle with pain that causes suffering. The pain sensation itself is an unconditioned reflex serving the function of alerting us to danger or tissue damage. The noxious sensation of pain is critical for our survival. The same applies to emotional pain, such as the “broken heart” we feel from the death of a loved one or loss of a relationship. We know that it is natural and necessary to feel such pain in the mourning process in order to heal and go on with our lives. In the case of chronic pain, causal and maintaining factors may be unclear, and efforts to reduce or eliminate the pain may be unsuccessful. In these cases, continuing attempts to control pain may be maladaptive, especially if they cause unwanted side effects or prevent involvement in valued activities, such as work, family, or community involvement (McCracken, Carson, Eccleston, & Keefe, 2004).